Right ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the norwood operation
| Autor: | Evelyn Lechner, Gertraud Geiselseder, Christoph Gross, Anna Hofer, Rudolf Mair, Gerald Tulzer, Eva Sames, Roland Gitter, Jürgen Steiner |
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| Jazyk: | angličtina |
| Předmět: |
Pulmonary and Respiratory Medicine
Heart Septal Defects Ventricular Male medicine.medical_specialty congenital hereditary and neonatal diseases and abnormalities medicine.medical_treatment Heart Ventricles Hemodynamics Pulmonary Artery Ventriculotomy Risk Assessment Sampling Studies Statistics Nonparametric Postoperative Complications medicine.artery Hypoplastic Left Heart Syndrome Medicine Humans cardiovascular diseases Cardiac Surgical Procedures Probability Retrospective Studies business.industry Anastomosis Surgical Infant Newborn Perioperative Prognosis Survival Analysis Norwood Operation Shunt (medical) Surgery Blood pressure Treatment Outcome Pulmonary artery cardiovascular system Norwood procedure Female business Cardiology and Cardiovascular Medicine |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. (5):1378-1384 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/S0022-5223(03)00389-1 |
| Popis: | Objective:Perioperative mortality, prolonged postoperative recovery after the Norwood procedure, and mortality between stage I and stage II might be related to shunt physiology. A right ventricular to pulmonary artery conduit offers a banded physiology in contrast to a Blalock-Taussig shunt. The purpose of this study was to assess the hemodynamic differences and their consequences in the postoperative course between Norwood patients with a Blalock-Taussig shunt and those with a right ventricular to pulmonary artery conduit.MethodsFrom October 1999 until May 2002, 32 unselected consecutive patients underwent a Norwood procedure at the General Hospital Linz. The first 18 patients received a Blalock-Taussig shunt. In the remaining 14 patients we performed a right ventricular to pulmonary artery conduit. Both groups were compared.ResultsThe diastolic blood pressure was significantly higher in the right ventricular to pulmonary artery conduit group (P < .001). Despite a higher FIO2, PO2 levels tended to be lower in the first 5 postoperative days. At the age of 3 months, catheterization labora- tory data showed a lower Qp/Qs ratio in the same group (0.86 [0.78; 1] versus 1.55 [1.15; 1.6]; P = .005) and a higher dp/dt (955 [773; 1110] vs 776 [615; 907]; P = .018). (Descriptive data reflect medians and quartiles [in brackets].) Hospital survival was 72% in the Blalock-Taussig shunt group versus 93% in the right ventricular to pulmonary ar- tery conduit group. Mortality between stage I and stage II was 23% in the Blalock-Taussig shunt group versus 0% in the right ventricular to pulmonary artery conduit group.ConclusionsA higher diastolic blood pressure and a lower Qp/Qs ratio were associated with a more stable and efficient circulation in patients with a right ventricular to pulmonary artery conduit. More intensive ventilatory support was necessary during the first postoperative days. We did not note any adverse effects of the ventriculotomy on ventricular performance. |
| Databáze: | OpenAIRE |
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